Explain in your own words the concept of "Advanced Directives", then explain the difference between Living Will and Durable Power of Attorney for Health Care.
Healthcare Risk Management class
Advance healthcare directive
An advance health care directive is a is a document of legal value in which a person directs or specifies what actions should be taken for their health on behalf of them if they are no longer able to make decisions for themselves because of illness or incapacity. It is also termed as a living will, personal directive, advance directive, medical directive or advance decision. Advanced directives have a legal status in itself in the U.S.
Advanced directives can be set in many forms :
1. A living will:
It is one form of advance directive, in which the patient leaves instructions for treatment.
2. A specific type of power of attorney or health care proxy:
In power of attorney or health care proxy, a person authorizes someone of his/her choice - an agent- to give directions on their behalf when they are incapacitated.
People who wish to give advanced directives are often encouraged to complete both documents in order to provide comprehensive guidance regarding their care.
Before the advanced directives based decision making, a certificate from two physicians is needed to prove:
If the person regains the ability to take medical decisions the appointed person or agent cannot continue to act on the person's behalf. Additional requirements are conditions are developed by states that apply only to decisions about life-sustaining medical treatments such as before the appointed agent can refuse a life-sustaining treatment on patient’s behalf, a second physician may have to confirm the concerned doctor's assessment that the patient is unable to make treatment decisions.
Advance directives are legally valid as soon as it is signed in front of the required witnesses. It can only be implemented after a physician thoroughly evaluates the person's condition and determines that the underlying conditions are in the specified “terminal illness" or "permanent unconsciousness as per the state's living will law. Hence it can not be implemented in emergency situations.
Advance directives are effective until the person change it or formulate a new advance directive. Any changes after completion are not allowed, unless a whole new document is created.
Advanced directives are the way to express patient’s wishes to family, friends, and health care professionals and to avoid confusion in treatment decisions. It preserves the right of the person to accept or refuse medical care. It may include the instructions on:
· use of dialysis and breathing machines
· resuscitation in case the breathing or heartbeat stops
· Tube feeding to sustain life
· Organ or tissue donation wishes
The living will and medical power of attorney (health care proxy) are two types of advance directives that are generally completed.
Living will:
A living will is a legal document that directs the loved ones, family members, friends and physicians regarding the person’s preferences for end-of-life care in case the person is incapacitated, without appointing anyone to make the health care decisions. It can include the details or patient’s preferences in different medical possibilities like artificial respiration, avoidance of nutrition or hydration, types of pain medications to allow and the preference to spend the last days at home or in the hospital. If the person becomes incapacitated, the concerned physicians and loved ones will look into the living will for guidance. It only addresses issues regarding the medical care person is still living.
A medical power of attorney:
It is otherwise known as the designation of a health care surrogate. It is also a legal document that allows the person to select anybody to make medical decisions on his/her behalf in case the person become temporarily or even permanently unable to make those decisions for themselves. The appointed person is also referred to as the attorney-in-fact or durable power of attorney for health care. Most of the people choose a family member, a relative, or a close friend as their surrogate decision maker. The appointed agent must act consistently with the patient’s wishes and must know the patient’s wishes. Same as the living will, a durable power of attorney for health care become valid only if the person becomes incapacitated and certified by physicians.
The difference:
A living will delineate the person’s wishes specifically but a
power of attorney for health care allows an appointed agent to make
health care decisions on behalf of the person. A living will be
active only on deathbed concerns but a durable power of attorney
for healthcare covers all health care decisions and lasts only as
long as the patient is incapable of making decisions for
him/herself. In the medical power of Attorney, the patient can tell
the agent about their wishes to act in regards to deathbed
issues.
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